• Health & Safety

H1N1 Flu & U.S. Schools: Frequently Asked Questions



These FAQs are updated by the U.S. Department of Education and are subject to change as the situation develops. Check www.ED.gov… for updates.

BACKGROUND

A severe form of influenza known as , commonly being called swine flu, has health officials around the world concerned. In the United States, the outbreak of has prompted school closures and cancellation of school-related events over the last few weeks. As the flu spreads, the Department of Education encourages school leaders, parents and students to know how to take action to reduce the spread of the virus and report illness.

Surveying the country, the overall impact of H1N1 flu on in the United States has been very small, so far. But it is still essential that we all prepare and plan—especially at our . Do what is appropriate for the health of your communities, your and your students, and rely on guidance from the Centers for Disease Control and Prevention (CDC).
Schools may be leading indicators and amplifiers of disease outbreaks, so it is important that school leaders watch out for illness among students and staff and take appropriate measures to prevent the spread of this virus. In addition, to reduce the spread of this new flu in the community, schools may consider dismissing students when there is an outbreak in their community.
Students and parents, too, should take common-sense measures to prevent contracting and spreading the flu.

The Department of Education (ED), in consultation with CDC and other federal public health experts, has attempted to answer here some common questions about H1N1 that are circulating among members of the education community. Remember that the best guidance on health questions comes from physicians, public health agencies and other health experts. The Department of Education has relied on CDC guidance to compile the information we are providing here, and we have provided Web links to their sites at the end of this Q&A. On ED.gov…, we also provide guidance on education policy and an emergency plan focused on elementary and secondary education, to help schools and districts deal with prolonged closures and other issues due to pandemic flu.

GENERAL GUIDANCE FOR SCHOOL LEADERS

Q: What should schools be doing now? Should we close our schools?
A: Schools should be alert to students exhibiting any influenza-like illness and should coordinate with local health departments if cases are suspected among students. Schools should consider implementing surveillance systems to determine if absences from schools are related to illness.

Flu symptoms include acute respiratory illness, such as fever greater than 37.8˚C or 100˚F, plus cough or sore throat. Other possible symptoms are runny nose, feeling very lethargic, loss of appetite, and in some cases, nausea, vomiting, and diarrhea. Many cases in the U.S. have recovered, but at least one death has occurred.

The CDC’s recommendations for mitigating influenza include encouraging students, staff, and faculty to stay home if they are sick to prevent transmission. Individuals should consider staying home if household family members are sick with suspected or confirmed cases of H1N1 flu. These steps, referred to as “non-pharmaceutical interventions,” can help prevent the further spread of illnesses that are passed easily from person to person.

In coordination with the local health department, school districts may consider closing impacted schools or the entire district, depending on the situation. Authorities for school closures vary by states and localities. Accordingly, local educational agencies, non-public schools, and institutions of higher education (IHEs) should consult their state’s pandemic influenza plan for more information about these authorities, state-level planning, and coordination. Information about state pandemic planning efforts can be found at: www.pandemicflu.gov….

If students are dismissed from schools or day care centers, schools should cancel all school-related gatherings and encourage parents and students to avoid gathering outside of school, including at malls, movies theaters, public libraries or friends’ houses in large groups.

Q: Should colleges and universities close if there is a suspected or confirmed case on campus?
A: Institutions of higher education (IHEs) should consult their all-hazards plans for decisions on student dismissal and cancellation of classes. State-run IHEs should consult their state pandemic influenza plans, which are posted at www.pandemicflu.gov…. The American College Health Association has also created guidance on pandemic planning.

Q: We have students or staff in Mexico now, or who have been there recently. Should we send them home?
A: There is no reason to exclude anyone from school merely because he or she has recently visited Mexico. If, however, an individual shows symptoms of influenza (fever above 37.8˚C or 100˚F, accompanied by cough or sore throat), they should seek medical care so they can be closely monitored and, as soon as possible, tested for the H1N1 flu virus. See below for more information about exposure to Mexico.

Q: When should we send a student or staff member to the doctor?
A: Any individual with flu-like symptoms—fever above 37.8˚C or 100˚F accompanied by cough or sore throat—should be referred to a physician or other medical professional who can test for the H1N1 flu virus.

Q: What should we do if we have no cases in our community?
A: CDC recommends that schools and childcare facilities in unaffected areas begin planning for the possibility of future closures and student dismissal. Many districts have developed pandemic plans as part of their all-hazards planning efforts and are encouraged to review those plans. If plans have not been developed, information on getting started can be found at: www.ed.gov…, rems.ed.gov…, and www.pandemicflu.gov….
Schools and IHEs should always promote good hand-washing and hygiene practices, including cough and sneezing etiquette and ensuring that tissues are disposed of after usage. Schools should also regularly be sure to clean and disinfect any frequently touched surfaces, following directions on manufacturer’s labels, particularly if students or faculty become ill at school. More information on preventing the spread of influenza can be found at: www.cdc.gov….

Q: What steps should school leadership take when there is a confirmed case of H1N1 flu among students or staff on campus?
A: School leadership should strongly consider school closure where there is a confirmed case of H1N1 flu among students or staff. Further, schools should also consider closing when a suspected case has occurred; for instance, a student has been exposed to someone with a confirmed case of H1N1 flu, particularly a person with whom that student lives.

Q: What should school leaders do if a sibling of one of their students has a confirmed case of the H1N1 flu (specifically, a sibling that attends another school)?
A: A sibling of someone with a confirmed case of H1N1 flu may continue to attend school, and should only remain at home if he/she develops symptoms or shows signs of potential illness. In such cases, it is recommended that care of the sick child, to the extent feasible, be delegated to a single caregiver, in an attempt to control the spread of the virus.

Q: What steps should school leadership take when there is a confirmed case of H1N1 flu within the larger community, but not necessarily at their school?
A: Consultation with local health officials is highly recommended. School dismissal may be recommended in a community if there is a confirmed case of H1N1 flu within the larger community, but not necessarily at their school. Additionally, school leaders should ascertain the degree to which the infected person could have been in contact with students at their school, and consult with local health officials. If the infected person has had direct contact with a student or other individual at the school, or in particular, several individuals, then school closure should be strongly considered.

Q: Should we call this H1N1 flu or “swine flu”?
A: H1N1 is the name of this particular strain of influenza. Influenza strains often originate with animals and get transmitted to humans. At this point in the progression of this strain, though, transmission appears to be entirely from human to human. Although it appears to have originated with pigs, then to have passed to humans working around pigs, the virus has combined with components of other types of influenza, including avian and human strains of the virus, to create this particular strain that appears to be easily passed from human to human, which is a concern. The H1N1 virus is not transmitted by food. You cannot get this influenza from eating pork or pork products. Eating properly handled and cooked pork and pork products is safe.

SCHOOL CLOSURE

Q: When a school closes and students are dismissed, how long should the school remain closed, and what exactly does that mean?
A: School leaders should consider both the incidence and severity of the H1N1 flu outbreak in determining when to reopen their schools. Public health experts recommend schools remain closed for seven days since the last known case in the school community. During the closure, school leaders should stay in touch with local health authorities to determine when to re-open.
School closure includes the cessation of routine classroom activities, as well as before- and after-school activities and extracurricular functions (including practices as well as scheduled competitions). School closures are far less effective if students continue to congregate elsewhere off campus, so school leaders should encourage parents and students to avoid congregating outside of school, too.

Q: Why, specifically, should schools be closed and students dismissed when a confirmed case of H1N1 flu has been identified?
A: Children are more susceptible than adults to infection and, compared with adults, are responsible for more secondary transmission within households. Compared with adults, children usually shed more influenza virus, and they shed virus for a longer period. They also are not skilled in handling their secretions, and they are in close proximity with many other children for most of the day at school. Schools, in particular, clearly serve as amplification points of seasonal community influenza epidemics, and children are thought to play a significant role in introducing and transmitting influenza virus within their households.

The reason for closing schools is to try and reduce the spread of the virus, through a process known as “social distancing.” Social distancing reduces opportunities for children to be around other children with whom they generally socialize as a part of their school day. Although this may be somewhat disruptive to families, it is necessary to limit students’ interactions with other students to the highest degree possible, in instances where the goal is to control a contagious virus, such as the H1N1 flu. When a school is closed due to a confirmed or suspect case of the H1N1 flu, parents should support social distancing by not allowing their children to go to stores, shopping malls, public libraries or other points or locations where young people are known to congregate and socialize. The purpose of social distancing is not to unnecessarily isolate children or make them feel bad, it is to protect their health and well-being. Parents should explain to their children why these actions are necessary.

Q: Can schools continue to feed children at school through the school meals programs if we close schools?
A: Handle a school closing for flu as you would for a snowstorm or holiday break. The U.S.
Department of Agriculture (USDA) cannot reimburse for school meals when schools are not in session and would not implement an alternative program to feed those children unless the closings became prolonged due to a pandemic. For more information, please see the USDA’s Web site: www.us….

Q: What should schools do if standardized testing is planned but they have suspected cases of H1N1 flu?
A: The health and safety of the school community comes first. Follow the CDC’s guidance on community mitigation measures if there are suspected or confirmed cases of flu at your school. The Department of Education (ED) developed education-related guidance that explains ED’s waiver authority for most requirements of No Child Left Behind (NCLB), which can be found at: www.ed.gov….
ED requests that states coordinate waiver requests to the Department. The process for requesting waivers is also explained in this guidance document.

Q: If we close schools and dismiss students, should we plan to continue educating students?
A: Many state and local educational agencies have been working on plans to consider educating students in the event of a prolonged school closure. State pandemic plans may include information about this, as may local plans.

Q: Are there resources available to help us start developing partnerships with community entities?
A: Information on developing community resources to support youth can be found at www.findyouthinfo.gov….

EXPOSURE TO MEXICO

Q: If a student took a vacation in Mexico recently, should the student be kept at home?
A: There is no reason to exclude a student from school merely because he or she has recently visited Mexico. If, however, that student shows symptoms of influenza (fever above 37.8˚C or 100˚F, accompanied by cough or sore throat), that child’s should see a medical provider so that their condition can be closely monitored and, as soon as possible, tested for the H1N1 flu virus.

Q: We have a school trip to Mexico planned, and students and their families are planning to travel to Mexico once school lets out for the summer. Should we cancel?
A: The CDC advises Americans to postpone and avoid all non-essential travel to Mexico until further notice. More information: wwwn.cdc.gov….

Q: For schools in areas where migrant or seasonal workers are employed, are there additional precautions that should be taken, particularly if those workers are from Mexico?
A: It’s important to remember—and to remind students, parents, and staff—that by their very nature, viruses are indiscriminate and equal opportunity. No one has immunity to this particular strain of influenza, so everyone is equally at risk of getting sick. Isolating, blaming, discriminating against or otherwise singling out individuals or sub-groups of a school’s population is not helpful; using common sense to prevent flu and monitoring for any symptoms is. School leaders should be vigilant about preventing bullying and harassment in schools. Additional information on bullying prevention can be found at: www.stopbullyingnow.org….

At any school, with any population, school health officials should assess risk and take action appropriately. Schools should continue to maintain clean environments and encourage common-sense preventive measures: wash hands, cover mouths when coughing, and avoid close contact. School closure should be strongly considered where there is a confirmed case of H1N1 flu and may be considered when there is an outbreak in the community.

ISOLATING CONFIRMED FLU CASES

Q: When should an infected child (or adult) be allowed to return to school?
A: While research on this strain of influenza is ongoing, it appears that individuals are contagious for about one day before symptoms begin and up to approximately seven days after symptom onset. Someone who has been infected with the H1N1 flu should stay home for 7 days after the start of illness and fever is gone and only return to school only after fever and other signs/symptoms of the illness have been absent for no less than seven days.

Q: Should special attention be made to cleaning our schools, in light of this outbreak?
A: School leaders should always uphold a high standard of cleanliness in their school buildings.
At this time, appropriate messages of carefully washing one’s hands and covering one’s mouth when coughing or sneezing, should be conveyed often to students. Schools should continue to clean frequently touched surfaces using standard products according to directions on the product label.

Q: Should we hand out masks at school?
A: Surgical face masks send a “stay away from me” message that can be helpful in preventing the spread of flu via close contact, but masks don’t entirely prevent the spread of viruses. Students and staff with flu-like symptoms or confirmed cases of the flu should isolate themselves at home, not put on a mask and continue to come to school.
School nurses or those caring for sick students may want to consider wearing OSHA-approved masks (also known as “respirators”). Guidance for health care workers can be found at: www.pandemicflu.gov….

SHARING INFORMATION

Q: What sort of information should school leaders share regarding this flu outbreak with parents as well as teachers?
A: Many parents have already heard of the potential for H1N1 flu outbreaks through the media, and as with many sensitive issues, misinformation is always a potential problem. School leaders are trusted figures in a community and should act quickly to provide accurate, yet not inflammatory, information about the spread of this virus, how to contain it and the steps they will need to take if school closure becomes necessary, and encouraging students or staff to stay home if they are sick. Working parents should be encouraged to plan for child care arrangements should their child’s school close.

Q: Are school districts permitted to disclose information on affected students to local,
State, and Federal authorities in the case of a severe pandemic?

A: Balancing an individual’s privacy with public health is important, but there are provisions for sharing such information appropriately between health and education authorities in the event of an emergency. The Family Educational Rights and Privacy Act (FERPA) permits school officials to disclose, without consent, education records, or personally identifiable information from education records, to appropriate parties in connection with an emergency, if knowledge of that information is necessary to protect the health or safety of the student or other individuals. ED provides additional guidance on FERPA and emergencies flu-related emergencies here. School officials may contact ED’s Family Policy Compliance Office with any questions by calling (202) 260-3887 or by e-mailing [email protected]

Q: Whom should we alert if our school closes due to H1N1 flu?
A: If you have confirmed a case of H1N1 flu at your school, you should immediately contact your public health department, which will be relaying information to state and federal health agencies.
If you choose to close your schools, even if it’s just a precautionary measure, please alert the
Department of Education’s Office of Safe and Drug-Free Schools by e-mail: [email protected]

Q: I have a question you haven’t answered. How can I ask it?
A: E-mail ED’s Office of Safe and Drug Free Schools at [email protected] We’ll do our best to get you an answer, and we’ll share the question and response here if we think there would be broad interest. Don’t forget, though, that the best guidance on health questions comes from physicians, health agencies and other experts. The Department of Education has relied on their guidance to compile the information we’re providing here.

ONLINE RESOURCES FOR SCHOOLS REGARDING FLU and PUBLIC HEALTH

Centers for Disease Control and Prevention:
• H1N1 Flu updates: www.cdc.gov…
• Recommendations for affected schools and communities:
www.cdc.gov…
• Information on disease prevention and mitigation: www.cdc.gov…
• The Centers for Disease Control and Prevention (CDC) Hotline (1-800-CDC-INFO) is available in English and Spanish, 24 hours a day, 7 days a week.
Pandemic Flu.Gov…: www.pandemicflu.gov…
• State pandemic influenza plans: www.pandemicflu.gov…
• Checklists for schools, communities, and individuals and families:
www.pandemicflu.gov…
Department of Education:
• Emergency planning for schools: www.ed.gov…
• Pandemic-specific planning information:
www.ed.gov…
• Readiness and Emergency Management for Schools’ Technical Assistance Center:
rems.ed.gov…
World Health Organization:
• General information about WHO actions: www.who.int…